Q. Can pain be caused by depression and anxiety?
A. People with depression and anxiety do experience more pain than average. We don’t know the exact cause. But we do know that pain can be more severe or last longer. And it can be harder to treat.
Up to two-thirds of patients seeking help for depression also report at least one pain symptom. Chronic pain is depressing. And some people “feel” depression as physically painful.
Pain shares some biological features with depression and anxiety. So psychotherapy and drug treatment aimed at the mental disorders can also relieve pain.
Cognitive behavioral therapy is one approach. It is an established treatment for anxiety and depression. This therapy is based on the idea that thoughts, feelings and sensations are all related. Patients who learn coping skills from a therapist can better manage their pain, rather than be victimized by it.
Stress makes pain worse, so relaxation training for stress can help ease pain. Techniques include progressive muscle relaxation, yoga and mindfulness training.
Hypnosis is another useful tool. A therapist helps a patient achieve a trancelike state and then provides positive suggestions. Some patients can learn self-hypnosis.
Some psychiatric drugs can relieve pain symptoms, too.
For example, some antidepressants may help with nerve pain. Anti-seizure drugs, often used as mood stabilizers, can regulate abnormal electrical activity in the brain. Chronic pain in particular involves nerve hypersensitivity. So that’s why some of these drugs may provide relief.
Patients with pain often find a combination of psychotherapy and medicine helps most. That approach is reminiscent of treatments for anxiety and depression.
Pain, depression and anxiety have a wide variety of causes. So good treatment usually depends upon working with your doctor to move carefully through the options. Hold on to what works and let go of the rest.
Dr. Michael Craig Miller is an assistant professor of psychiatry at Harvard Medical School.